Evaluation de la performance de la surveillance intégrée de la maladie et de la riposte dans la zone sanitaire Ouidah-Kpomassè-Tori-Bossito, au Bénin / NA

Introduction : La Surveillance Intégrée des Maladies et Riposte est une stratégie initiée en 1998 par le Bureau Régional de l'Organisation mondiale de la Santé pour l'Afrique, pour renforcer la capacité des pays africains à mener des activités de surveillance des maladies transmissibles et réagir efficacement face aux situations d'urgence sanitaire. L'objectif de la présente étude était d'évaluer la performance de la surveillance intégrée des maladies et riposte dans la zone sanitaire Ouidah-Kpomassè-Tori-Bossito en 2020. Méthodes : Il s'agissait d'une étude évaluative, ayant porté sur les formations sanitaires et le personnel impliqué dans la surveillance épidémiologique, sélectionnés respectivement par choix aléatoire simple et par choix raisonné. La performance de la surveillance intégrée des maladies et riposte a été appréciée par les éléments constitutifs des composantes "structure", "processus", "résultats" conformément au modèle de Donabedian et selon l'échelle de Varkevisser. Résultats: Au total 19 formations sanitaires et 19 agents de santé ont été inclus dans l'étude. La performance de la surveillance intégrée des maladies et riposte était moyenne, avec un bon niveau de la composante "structure" et un niveau moyen pour les composantes "processus" et "résultats". D'importantes insuffisances avaient été observées sur les fonctions confirmation, analyse, rétro-information et complétude des rapports. Conclusion: La performance de la surveillance intégrée des maladies et riposte nécessite une amélioration en vue d'une riposte appropriée face aux urgences de santé publique dans la zone sanitaire et une résilience du système de santé. Mots-clés: Performance, surveillance intégrée des maladies et riposte

Introduction: Integrated Disease Surveillance and Response is a strategy initiated in 1998 by the World Health Organization Regional Office for Africa, to strengthen the capacity of African countries to conduct communicable disease surveillance and response activities. effectively in health emergencies. The objective of this study was to assess the performance of integrated disease surveillance and response in the Ouidah-Kpomassè-Tori-Bossito health zone in 2020. Methods: This was an evaluative study, having focused on health facilities and personnel involved in epidemiological surveillance, selected respectively by simple random choice and by reasoned choice. The performance of the integrated disease surveillance and response was assessed by the constituent elements of the components "structure", "process", "results" in accordance with the Donabedian model and according to the Varkevisser scale. Results: A total of 19 health facilities and 19 health workers were included in the study. The performance of integrated disease surveillance and response was average, with a good level of the "structure" component and an average level for the "process" and "outcome" components. Significant shortcomings were observed in the confirmation, analysis, feedback and completeness of reports functions. Conclusion: The performance of integrated disease surveillance and response requires improvement for an appropriate response to public health emergencies in the health zone and health system resilience

[Sexual Behaviours at Risk of HIV Infection among Male to Female Transgender People in Benin]. / Comportements sexuels à risque d'infection à VIH chez les transgenres homme vers femme au Bénin.

Transgender people are a population vulnerable to the human immunodeficiency virus (HIV) due to frequent adoption of risky sexual behaviours. To reorient prevention interventions in this population, this study aims to identify factors associated with high-risk sexual behaviours. It's a cross-sectional study. The subjects were recruited by driven respondents sampling throughout the country in December 2017. They included subjects who identified themselves as Male to Female transgender and who adopted such an image. The data were collected by questionnaire. The variables were multi-partnership and condom use during sex. Proportion comparisons were made with Pearson's Chi2 test and multiple logistic modeling was performed. The prevalence of multipartnership was 83.85% and the prevalence of condom use during last intercourse was 92.41%. Sexual risk behaviours were associated with age (P = 0.004), occupation (P = 0.000), education level (P = 0.025), family and friends' attitudes towards transgender status (P = 0.044) and HIV prevention knowledge level (P < 0.05). The factors identified should be integrated into transgender interventions in Benin with a focus on improving knowledge in HIV prevention.

Pour réorienter les interventions de prévention à l'attention des transgenres homme vers femme, cette étude vise à identifier les facteurs associés à leurs comportements sexuels à risque d'infection au virus de l'immunodéficience humaine (VIH). L'étude était transversale avec un recrutement par technique en boule de neige, réalisée en décembre 2017. Les variables d'intérêt étaient le multipartenariat sexuel et l'utilisation du préservatif lors des rapports sexuels. Une modélisation logistique multiple a été faite. La prévalence du multipartenariat était de 83,8 % et celle de l'utilisation du préservatif lors du dernier rapport sexuel de 92,4 %. Les comportements sexuels à risque étaient associés à l'âge (p = 0,004), à la profession (p = 0,000), au niveau d'instruction (p = 0,025), à l'attitude de l'entourage face au statut de transgenre (p = 0,044) et au niveau de connaissance en matière de prévention du VIH (p < 0,05). Les facteurs identifiés sont des pistes à intégrer dans les interventions pour les transgenres au Bénin avec un accent sur l'amélioration de la connaissance en prévention du VIH.

[Factors associated with TT2 + coverage in pregnant women in the Zogbodomey- Bohicon-Zakpota Health Zone, Benin in 2013]. / Facteurs associes a la couverture en VAT2+ chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey-Bohicon-Zakpota au Benin en 2013.

AIMS: Our study aimed to investigate factors associated with TT2+ coverage (at least two doses of tetanus-toxoid vaccine) in pregnant women in the Zogbodomey- Bohicon-Zakpota Health Zone, Benin in 2013. MATÉRIALS AND METHODS: A cross-sectional, descriptive and analytical study was conducted between June-July 2013 on mothers of children aged 0-11 months. The sampling method of immunization coverage cluster of WHO has been adapted. Logistic regression was used to identify factors associated to with TT2+. RESULTS: Our study included 210 mothers of children aged 0-11 months. TT2+ coverage of the women surveyed were 61.7% [95% CI 61.4 to 62.0]. The factors associated with TT2+ coverage were: the amount of antenatal care, the use of a private health center, knowledge of the immunization schedule, the use of radio and television, marital status, occupation, waiting time, residence, fear of undesirable reactions, the permanence of immunization services, education level, distance, family support and explanation of the immunization schedule to the women. CONCLUSION: Measures to improve TT2+ coverage should put more emphasis on these identified factors to hope to eliminate maternal and neonatal tetanus.

BUT: Notre étude avait pour objectif d'étudier les facteurs associés à la faible couverture en Vaccin Anti Tétanique deuxième dose (VAT2+) chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey-Zakpota-Bohicon au Benin. MATÉRIELS ET MÉTHODES: Une étude transversale, descriptive et analytique a été menée en juin-juillet 2013 et a porté sur les mères d'enfants de 0­11 mois. La méthode de couverture vaccinale en grappes de l'OMS a été utilisée. Les données ont été analysées avec Epi Info 7 et Stata 11. La régression logistique a été utilisée pour déterminer les facteurs associés à la VAT2+. RÉSULTATS: La couverture en VAT2 + des 210 mères enquêtées était de 61,7 % IC95% =[61,4 ­62,0]. Les facteurs associés à la couverture en VAT2+ étaient : le nombre de CPN, le recours à un centre de santé privé, la connaissance et l'explication du calendrier vaccinal, l'utilisation des médias, le statut matrimonial, la profession, le temps d'attente, la résidence, la peur des réactions secondaires, la permanence des services de vaccination, le niveau d'instruction, la distance, le soutien de la famille. CONCLUSION: Les mesures visant à améliorer la couverture en VAT2+ doivent davantage mettre l'accent sur ces facteurs pour espérer éliminer le tétanos maternel et néonatal.

[Prevalence and characteristics of chronic pain with neuropathic component at Parakou in northern Benin in 2012]. / Prévalence et caractéristiques des douleurs chroniques avec caractère neuropathique en population générale à Parakou au nord du Bénin en 2012.

The burden of chronic and neuropathic pain is high making it an important public health problem. The epidemiology is not well known in the general population in sub-Saharan Africa. We aimed to determine the prevalence of chronic pain with a neuropathic component at Tititou in Parakou in northeastern Benin. A cross-sectional study was conducted from 1st April to 31 May 2012 and included 2314 people in a door-to-door survey. Chronic pain was defined as pain occurring for more than three months. Neuropathic pain was assessed with the DN4 score. A neurological exam was performed by a young physician for all people with chronic pain. During the interview, sociodemographic data, past medical history, weight and height were recorded. Multivariate logistic regression was performed to analyze the main associated factors. Among the 2314 people included in this survey, 49.7% were male. The mean age was 32.3 ± 13.1 years. Nine hundred seven reported pain occurring for more than 3 months. The prevalence of chronic pain was 39.2% (CI95%: 29.3-34.7). It was more frequent in females, older people, among diabetics, people with a history of any surgery, stroke, brain trauma, and alcoholism. The prevalence of chronic pain with a neuropathic component was 6.3% (CI95%: 5.0-7.9). The main associated factors were age, matrimonial status, professional occupation, body mass index, diabetes, history of zoster, history of any surgery, brain trauma. People with neuropathic pain often reported pain with burning (87.6%), prickling (82.8%), numbness (66.9%), tingling (63.4%), and lightning pain (48.3%). The main locations were the lower limbs and low back pain. This study suggested the high frequency of chronic neuropathic pain in the general population in Parakou compared with rates reported in western countries.

[Factors associated with low coverage of tetanus-toxoid vaccine in pregnant women in the Health Zone Zogbodomey- Bohicon-Zakpota, Benin]. / Facteurs associes a la faible couverture en vaccin antitetanique chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey-Bohicon-Zakpota au Benin.

AIMS: Our study aimed to investigate associated factors with TT2 + coverage (at least two doses of tetanus-toxoid vaccine) in pregnant women in the Health Zone Zogbodomey- Bohicon-Zakpota, Benin in 2013. MATÉRIALS AND METHODS: A cross-sectional, descriptive and analytical study was conducted in june-July 2013 on mothers of children aged 0-11 months. The sampling method of immunization coverage cluster of WHO has been adapted. Logistic regression was used to identify factors associated to with TT2 +. RESULTS: Our study included 210 mothers of children aged 0-11 months. TT2 + coverage of the women surveyed were 61.7% [95% CI 61.4 to 62.0]. The final model, factors associated with TT2 + coverage were: the number of antenatal care, the use of a private health center, knowledge of the immunization schedule, the use of radio and television, marital status, occupation, waiting time, residence, fear of undesirable reactions, the permanence of immunization services, education level, distance, family support and explanation of the immunization schedule the woman. Conclusion: Measures to improve TT2 + coverage should put more emphasis on these identified factors to hope to eliminate maternal and neonatal tetanus.

BUT: Notre étude avait pour objectif d'étudier les facteurs associés à la faible couverture en Vaccin Anti Tétanique deuxième dose (VAT2+) chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey-Zakpota-Bohicon au Benin. MATÉRIELS ET MÉTHODES: Une étude transversale, descriptive et analytique a été menée en juin-juillet 2013 et a porté sur les mères d'enfants de 0­11 mois. La méthode de couverture vaccinale en grappes de l'OMS a été utilisée. Les données ont été analysées avec Epi Info 7 et Stata 11. La régression logistique a été utilisée pour déterminer les facteurs associés à la VAT2+. RÉSULTATS: La couverture en VAT2 + des 210 mères enquêtées était de 61,7 % IC95% =[61,4­62,0]. Les facteurs associés à la couverture en VAT2+ étaient: le nombre de CPN, le recours à un centre de santé privé, la connaissance et l'explication du calendrier vaccinal, l'utilisation des médias, le statut matrimonial, la profession, le temps d'attente, la résidence, la peur des réactions secondaires, la permanence des services de vaccination, le niveau d'instruction, la distance, le soutien de la famille. CONCLUSION: Les mesures visant à améliorer la couverture en VAT2+ doivent davantage mettre l'accent sur ces facteurs pour espérer éliminer le tétanos maternel et néonatal.

Seroprevalence et facteurs associes au statut serologique des enfants nes de meres seropositives au VIH dans les sites de prevention de Cotonou au Benin

L'objectif de l'etude etait de determiner les facteurs qui sont associes au statut serologique des enfants nes de meres seropositives dans quatre sites de Prevention de la Transmission Mere-Enfant (PTME) de Cotonou. Une etude transversale et retrospective; a double volet quantitatif et qualitatif a porte sur 114 dossiers d'enfants nes de meres seropositives ainsi que leurs meres en 2010; 60 meres seropositives ayant frequente ces sites et 29 agents de sante assurant leur prise en charge en 2011. Elle a ete basee sur le depouillement des dossiers medicaux; des entretiens individuels et des observations du cadre de travail. Des analyses bi-variees ont ete realisees pour rechercher les facteurs associes au statut serologique de l'enfant dans Epi Info 3.5.3. L'etude a montre que le traitement aux ARV; le type du VIH; le sexe de l'enfant; la prophylaxie au Cotrimoxazole ont ete associes significativement au statut serologique de l'enfant. Le cadre de travail inadequat; les ruptures de stock des ARV; Cotrimoxazole et reactifs et leur gestion insuffisante; les difficultes pour faire face aux depenses supplementaires liees aux soins ont ete releves. En conclusion; l'acces aux ARV et au Cotrimoxazole et leur gestion adequate; l'observance rigoureuse des traitements et le soutien financier aux meres seropositives contribueront a la baisse considerable du taux de transmission de la mere a l'enfant du VIH dans les sites PTME de Cotonou

Facteurs associes a la faible couverture en vaccin antitetanique chez les femmes enceintes dans la zone sanitaire de Zogbodo Mey-Bohicon-Zakpota au Benin

But : Notre etude avait pour objectif d'etudier les facteurs associes a la faible couverture en Vaccin Anti Tetanique deuxieme dose (VAT2+) chez les femmes enceintes dans la Zone Sanitaire de Zogbodomey Zakpota Bohicon au Benin. Materiels et Methodes: Une etude transversale; descriptive et analytique a ete menee en juin juillet 2013 et apporte sur les meres d'enfants de 0 11 mois. La methode de couverture vaccinale en grappes de l'OMS a ete utilisee. Les donnees ont ete analysees avec Epi Info 7 et Stata 11. La regression logistique a ete utilisee pour determiner les facteurs associes a la VAT2+. Resultats: La couverture en VAT2 + des 210 meres enquetees etait de 61;7 IC95 =[61;4 62;0]. Les facteurs associes a la couverture en VAT2+ etaient : le nombre de CPN; le recours a un centre de sante prive; la connaissance et l'explication du calendrier vaccinal; l'utilisation des medias; le statut matrimonial; la profession; le temps d'attente; la residence; la peur des reactions secondaires; la permanence des services de vaccination; le niveau d'instruction; la distance; le soutien de la famille. Conclusion : Les mesures visant a ameliorer la couverture en VAT2+ doivent davantage mettre l'accent sur ces facteurs pour esperer eliminer le tetanos maternel et neonatal

Prevalence of hypertension and associated risk factors in Benin.

BACKGROUND: Hypertension is one of the main risk factors of cardiovascular diseases. There has been a lack of data on this risk factor in the general population in Benin. The aim of this study was to determine the prevalence of hypertension and identify the associated risk factors in Benin. METHODS: A cross-sectional study was conducted from July to August 2008 in Benin's 12 departments. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. The sample included 6853 subjects 25-64 years of age, randomly selected by five-stage random sampling. Blood pressure was measured using standard procedures. Data was processed and analyzed using EPI DATA and STATA 9.2 software. Prevalence levels were compared using Pearson's chi(2) and means with the Student t-test. Univariate and multivariate regression analysis, taking the sampling method into account, was used to identify risk factors. RESULTS: The sample comprised 49.5% females, the 25- to 34-year-old age group was the largest, and the mean age was 42.7±12.4 years. The prevalence of hypertension was 27.9% [95% CI: 26.3-29.5%], 77.5% of the subjects were unaware of their high blood pressure, and 81.6% had not taken their drugs two weeks before the survey. Prevalence of known hypertension was 6.9%, prevalence of treated hypertension 4.8%, and prevalence of controlled hypertension 1.9%. Age and obesity were significantly associated with hypertension. Department and profession were not associated with hypertension. CONCLUSION: This study showed a high prevalence of hypertension in the general population in Benin. Better management of this risk factor will contribute to reducing morbidity and mortality due to cardiovascular diseases.

CD4+ T-lymphocytes natural decrease in HAART-naïve HIV-infected adults in Abidjan.

OBJECTIVE: To study the CD4 natural decrease and its determinants in sub-Saharan African HIV-infected adults. METHOD: We performed a 7-year prospective cohort study, with biannual CD4 measurement. Follow-up was censored at the first severe morbidity event or at HAART initiation. Changes in CD4 values were studied by jointly modelling (a) the correlation between repeated measures through a linear mixed model and (b) the time to drop-out through a survival model. RESULTS: 690 patients were followed up during 1,382 person-years. Contrasting with the baseline CD4 count and percentage, which were associated with numerous variables, the slopes of both CD4 count and CD4 percentage in the absence of severe morbidity episode were only associated with the follow-up time and with the baseline body mass index (BMI). The mean annual natural decrease in CD4 count (CD4%) was estimated at -81/mm3 (-2.2%), -69/mm3 (-1.7%), and -55/mm3 (-1.2%) for patients with baseline BMI at 16 kg/m2, 20.4 kg/m2, and 25 kg/m2, respectively (p < .001). A steeper decline in the CD4 count was independently associated with a shorter event-free follow-up time. CONCLUSION: These estimates of the CD4 natural decrease in sub-Saharan African patients, while they did not experience any episode of severe morbidity and before they initiate HAART, are in the bracket of those previously reported in industrialized countries. In sub-Saharan African settings with CD4 count being measured less frequently than in industrialized countries, the CD4 should be monitored more closely among adults with low BMI.

Evidence of behaviour change following a hygiene promotion programme in Burkina Faso.

OBJECTIVES: To determine whether a large, 3-year hygiene promotion programme in Bobo-Dioulasso, Burkina Faso, was effective in changing behaviours associated with the spread of diarrhoeal diseases. The programme was tailored to local customs, targeted specific types of behaviour, built on existing motivation for hygiene, and used locally appropriate channels of communication. METHODS: Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months). Four surveys were carried out: three prior to the programme and one in 1998 (after the programme had been running for 3 years), using structured observation of hygiene behaviours in the participants' homes to document changes in target behaviours. FINDINGS: After the programme had run for 3 years, three-quarters of the mothers targeted had had contact with programme activities. Half could cite the two main messages of the programme correctly. Although the safe disposal of children's stools changed little between 1995 and 1998 (80% pre-intervention, 84% post-intervention), hand-washing with soap after cleaning a child's bottom rose from 13% to 31%. The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17%. CONCLUSION: Hygiene promotion programmes can change behaviour and are more likely to be effective if they are built on local research and use locally appropriate channels of communication repeatedly and for an extended time.

[Impaired fertility in women infected with HIV-1. Implications for sentinel serosurveillance]. / Réduction de la fertilité chez les femmes infectées par le VIH-1. Implications pour la sérosurveillance sentinelle.

BACKGROUND: Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance. METHODS: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent. RESULTS: Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women. CONCLUSIONS: Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.

Stabilization of HIV infection rates in urban Burkina Faso, 1995-1999.

The objectives of this study were to monitor the trends of the HIV epidemic between 1995 and 1999 among pregnant women in Bobo-Dioulasso, the second largest town of Burkina Faso, and to discuss the possible effect of preventive interventions (condom availability) on sexual transmission of HIV in this context. Age-specific trends in HIV prevalence obtained from sentinel surveillance programme were analysed. Among antenatal clinic attendees, HIV prevalence was 7.5% (n=401) in 1995, 10% (n=200) in 1996, 7.6% (n=448) in 1997, 8.4% (n=642) in 1998 and 5.3% (n=716) in 1999 without demonstrated temporal trend (P=0.12). The average number of condoms available per person (aged 15-49 years) per year increased from 0.6 in 1992 to 5.7 in 1995 and 6.0 in 1999. Anonymous surveys are less subject to selection bias and suggest a stabilization of the HIV prevalence around 7.3% in Bobo-Dioulasso. Distribution of condoms could explain at least, partly, this stabilization of the HIV epidemic.

Serological diagnosis of human immuno-deficiency virus in Burkina Faso: reliable, practical strategies using less expensive commercial test kits.

Reported are the results of a cross-sectional survey in Burkina Faso to identify reliable, practical strategies for the serological diagnosis of HIV-1 and/or HIV-2 infections, using less-expensive commercial test kits in various combinations, as an alternative to the conventional Western blot (WB) test, which costs US$ 60. Serum samples, collected from blood donors, patients with acquired immunodeficiency syndrome (AIDS) and pregnant women, were tested between December 1995 and January 1997. Twelve commercial test kits were available: five Mixt enzyme-linked immunosorbent assays (ELISA), three Mixt rapid tests, and four additional tests including monospecific HIV-1 and HIV-2 ELISA. The reference strategy utilized a combination of one ELISA or one rapid test with WB, and was conducted following WHO criteria. A total of 768 serum samples were tested; 35 were indeterminate and excluded from the analysis. Seroprevalence of HIV in the remaining 733 sera was found to be 37.5% (95% confidence interval: 34.0-41.1). All the ELISA tests showed 100% sensitivity, but their specificities ranged from 81.4% to 100%. GLA (Genelavia Mixt) had the highest positive delta value, while ICE HIV-1.0.2 (ICE) produced the most distinct negative results. Among the rapid tests, COM (CombAIDS-RS) achieved 100% sensitivity and SPO (HIV Spot) 100% specificity. Various combinations of commercial tests, according to recommended WHO strategies I, II, III, gave excellent results when ICE was included in the sequence. The best combination of tests for strategy II, which achieved 100% sensitivity and specificity, was to use ICE and COM, the cost of which was US$ 2.10, compared with US$ 55.60 for the corresponding conventional strategy. For strategy III, the best combination, which achieved 100% sensitivity and specificity, was to use ICE, ZYG (Enzygnost Anti HIV-1/HIV-2 Plus) and COM, the cost of which was US$ 2.90 (19.2 times lower than the corresponding strategy requiring WB). No rapid test combination showed 100% sensitivity and specificity. Our results indicate that the serodiagnosis of HIV in Burkina Faso is possible by using reliable, less-expensive strategies which do not require Western blot testing. Moreover, there is a choice of strategies for laboratories working with or without an ELISA chain.